MEDICARE: ERICKA L BRYANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	118345	TX
2	225XM0800X	Mental Health Occupational Therapist	19847	CA

General Provider Information

NPI Number	:	1548797400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICKA L BRYANT

Provider Business Mailing Address
First Line	:	920 TIERNEY RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-6849
Country	:	US
Telephone Number	:	682-667-9697
Fax Number	:	281-408-2155

Provider Business Practice Location Address
First Line	:	920 TIERNEY RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-6849
Country	:	US
Telephone Number	:	682-667-9697
Fax Number	:	281-408-2155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	02/25/2020

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Directions to “ ERICKA L BRYANT ” Practice Location

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